Spinal shock

1. SPINAL SHOCK
By: Dr Ismah, Ortho department
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2. Contents
 Definition
 Anatomy
 Pathophysiology
 Phases
 Vs. neurogenic shock
 Management
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3. Definition
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 Immediate temporary loss of total power,
sensation and reflexes below the level of injury
 + Loss of bulbo-cavernous reflex
 Usually recover within 24-48 hrs
-oxford handbook-

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bulbo-cavernous reflex

5. Anatomy
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http://www.radiologyassistant.nl/
en/p4906c8352d8d2/spine-thoracolumbar-
injury.html
Dennis three
column
-spine stability

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Walter B. Greene. Netter's Orthopaedics 1st ed. 2006

7. Pathophysiology
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TRAUMA -- > SCI
- causes a concussion like injury to spinal cord
- total sensory and motor power loss and loss of all reflexes for
initial some period
- followed by then gradual recovery of reflexes
 Reflexes in the SC caudal to the SCI are depressed
(areflexia)
 This state of sensory and motor loss along with total loss of
reflexes following trauma is known as spinal shock
 The 'shock' in spinal shock does not refer to circulatory
collapse

8. Phases
Phase Time Physical exam
findings
Underlying physiological
event
1 0-1 days Areflexia Loss of descending
facilitation
2 1-3 days Initial reflex return Denervation
supersensitivity
3 1-4 weeks Hyperreflexia Axon-supported synapse
growth
4 1-12 months Hyperreflexia,
Spasticity
Soma-supported synapse
growth
http://www.nature.com/sc/journal/v42/n7/full/3101603a.html
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9. Phase 1:
 A complete loss or weakening of all reflexes below
the level of spinal cord injury
 Spinal concussion caused the neurons involved in
various reflex arcs and the neural input from the
brain become hyperpolarized and unresponsive.
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10. Phase 2
 Characterized by the return of some reflexes. The
first reflexes to reappear is the bulbocavernosus
reflex
 The reason reflexes return is the hypersensitivity of
reflex muscles following denervation; more
receptors for neurotransmitters are expressed and
are therefore they are easier to stimulate.
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11. Phases 3 and 4
 Characterized by hyperreflexia
 Neurons below the injury attempt to reestablish
the synapses
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12. Spinal vs neurogenic shock
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Spinal shock Neurogenic shock
Definition Immediate temporary loss
of total power, sensation
and reflexes below the level
of injury
Sudden loss of the
sympathetic nervous
system signals
BP Hypotension Hypotension
Pulse Bradycardia Bradycardia
Bulbocaverno
Absent Variable
sus reflex
Motor Flaccid paralysis Variable
Time 48-72 hrs immediate after SCI
Mechanism Peripheral neurons become
temporarily unresponsive to
brain stimuli
Disruption of autonomic
pathways  loss of
sympathetic tone and
vasodilation
http://www.orthobullets.com/spine/2006/spinal-cord-injuries

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MANAGEMENT
Immobilisation
-Spinal board
-Cervical collar
1) Monitor
neurological status
2) Cord/cauda-equina
Sx
Methylprednisolone
-given as bolus of 30 mg
/ kg body wt
-followed by infusion at
5.4 mg / kg / hour for 24
hours
Symtomatic
medication:
-Pain relief
-Constipation
DVT prophylaxis

14. The National Spinal Cord Injury Study
(NASCIS)
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 NASCIS 3 USA, 1997
 High dose methylprednisolone
 Prevent secondary injury of SCI
 Rx start within 3 hrs for 24 hrs
 Side effects: immunosuppression, GIT bleeding,
hyperglycemia and ARDS

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16. 16 Thank you